中性粒细胞与淋巴细胞比值联合磷脂酶A2可迅速筛选急诊后循环缺血性卒中的高危人群

李瑾.中性粒细胞与淋巴细胞比值联合磷脂酶A2可迅速筛选急诊后循环缺血性卒中的高危人群[J].内科急危重症杂志,2024,30(5):435-439

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DOI：10.11768/nkjwzzzz.20240512

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作者	单位	E-mail
李瑾	南京大学医学院附属鼓楼医院	guss2926@163.com

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中文摘要:

摘要目的：分析中性粒细胞与淋巴细胞比值（NLR）联合脂蛋白相关磷脂酶A2（Lp-PLA2)对急诊以单纯头晕为主诉的患者发生后循环缺血性卒中的预测价值。方法：回顾性分析急诊科收治的以单纯头晕为主诉的408例患者的临床资料，按是否发生急性后循环脑梗死分为脑梗死组(117例)和非脑梗死组(291例)，比较2组的基本资料和急诊入院资料，采用多因素logistic回归分析发生后循环缺血性卒中的独立危险因素，并应用受试者工作特征 (ROC)曲线评估NLR联合Lp-PLA2对急诊单纯头晕患者发生后循环缺血性卒中的预测价值。结果：2组年龄、高血压及糖尿病史、吸烟史方面比较，差异有统计学意义（P均<0.05）。多因素Logistic 回归分析显示，年龄、高血压及糖尿病史、NLR、Lp-PLA2是急诊单纯头晕患者新发后循环缺血性卒中的独立危险因素。NLR预测单纯头晕患者发生后循环缺血性脑卒中的ROC 曲线下面积（AUC）为0.810（95%CI 0.763~0.856,P<0.05)，最佳截断值为2.87，敏感度为0.812，特异性为0.732。Lp-PLA2预测单纯头晕患者发生后循环缺血性脑卒中的AUC为0.840（95%CI0.797~0.884,P<0.05)，最佳截断值为203.5ng/mL，敏感度为0.761，特异性为0.804。NLR联合Lp-PLA2 预测单纯头晕患者发生后循环缺血性脑卒中的AUC为0.851（95%CI0.808~0.894,P<0.05)，最佳截断值为0.620，敏感度为0.829，特异性为0.794。结论：NLR联合Lp-PLA2能迅速筛选出单纯头晕为〖JP2〗主诉的患者中发生后循环缺血性卒中的高危人群，从而进行积极的血管评估及急诊头颅磁共振来避免漏诊，特别是高龄、合并高血压、糖尿病的患者。

英文摘要:

Abstract Objective: To analyze the predictive value of neutrophil/lymphocyte ratio (NLR) combined with lipoprotein-associated phospholipase A2 (Lp-PLA2) in the occurrence of post-circulation ischemic stroke in patients with simple dizziness as the main complaint in the emergency department. Methods:The clinical data of 408 patients with simple dizziness as the main complaint in the emergency department were retrospectively analyzed. According to whether acute posterior circulation cerebral infarction occurred, the patients were divided into cerebral infarction group (117 cases) and non-cerebral infarction group (291 cases). The basic data and emergency admission data of the two groups were compared. Multivariate logistic regression was used to analyze the independent risk factors of posterior circulation ischemic stroke, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of NLR combined with Lp-PLA2 for posterior circulation ischemic stroke in patients with simple dizziness in the emergency department. Results: There were significant differences in age, history of hypertension, diabetes mellitus and smoking between the two groups (all P<0.05). Multivariate logistic regression analysis showed that age, history of hypertension and diabetes, NLR, Lp-PLA2 were independent risk factors for new posterior circulation ischemic stroke in patients with simple dizziness in emergency department. The area under the ROC curve of NLR for predicting posterior circulation ischemic stroke in patients with simple dizziness was 0.810 (95% CI:0.763-0.856,P<0.05), and the best cutoff point was 2.87, the sensitivity was 0.812, and the specificity was 0.732. The area under the ROC curve of Lp-PLA2 in predicting posterior circulation ischemic stroke in patients with simple dizziness was 0.840 (95% CI:0.797-0.884, P<0.05), the best cutoff point was 203.5, the sensitivity was 0.761, and the specificity was 0.804. The area under the ROC curve of NLR combined with Lp-PLA2 in predicting posterior circulation ischemic stroke in patients with simple dizziness was 0.851 (95% CI: 0.808-0.894,P<0.05), the best cutoff point was 0.620, the sensitivity was 0.829, and the specificity was 0.794. Conclusion: NLR combined with Lp-PLA2 can quickly screen the high-risk group of posterior circulation ischemic stroke in patients with simple dizziness as the main complaint, so as to carry out active vascular evaluation and emergency cranial magnetic resonance to avoid missed diagnosis, especially in elderly patients with hypertension and diabetes.